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Factors associated with depression are usually identified from cross-sectional studies.
We explore the relative roles of onset and recovery in determining these associations.
Hazard ratios for onset and recovery were estimated for 39 risk factors from a cohort study of 10 045 general practice attendees whose depression status was assessed at baseline, 6 and 12 months.
Risk factors have a stronger relative effect on the rate of onset than recovery. The strongest risk factors for both onset and maintenance of depression tend to be time-dependent. With the exception of female gender the strength of a risk factor's effect on onset is highly predictive of its impact on recovery.
Preventive measures will achieve a greater reduction in the prevalence of depression than measures designed to eliminate risk factors post onset. The strength of time-dependent risk factors suggests that it is more productive to focus on proximal rather than distal factors.
In elderly men as in elderly women, endogenous estradiol may play an important role in age-related cognitive impairment. To explore the relation between estradiol, cognition, dementia, and cerebral atrophy, Muller and Geerlings performed a systematic literature review. In their review, the authors found that most studies in elderly men do not report significant associations between estradiol levels and cognitive performance, cognitive decline, dementia, or brain atrophy. Some studies, however, do imply that higher estradiol levels are potentially detrimental, although to the extent that a relation may exist, the magnitude of risk is likely small. Given the long preclinical phase of Alzheimer's disease (AD), it is difficult to infer causality, even in longitudinal studies with long follow-up. Muller and Geerling indicated that the relation between estradiol and vascular risk merits further study with respect to AD. In addition, they provide evidence that sex hormone binding globulin (SHBG) levels and aromatase activity are relevant to questions of AD pathogenesis.
There is evidence that the prevalence of common mental disorders varies
To compare prevalence of common mental disorders in general practice
attendees in six European countries.
Unselected attendees to general practices in the UK, Spain, Portugal,
Slovenia, Estonia and The Netherlands were assessed for major depression,
panic syndrome and other anxiety syndrome. Prevalence of DSM–IV major
depression, other anxiety syndrome and panic syndrome was compared
between the UK and other countries after taking account of differences in
demographic factors and practice consultation rates.
Prevalence was estimated in 2344 men and 4865 women. The highest
prevalence for all disorders occurred in the UK and Spain, and lowest in
Slovenia and The Netherlands. Men aged 30–50 and women aged 18–30 had the
highest prevalence of major depression; men aged 40–60 had the highest
prevalence of anxiety, and men and women aged 40–50 had the highest
prevalence of panic syndrome. Demographic factors accounted for the
variance between the UK and Spain but otherwise had little impact on the
significance of observed country differences.
These results add to the evidence for real differences between European
countries in prevalence of psychological disorders and show that the
burden of care on general practitioners varies markedly between
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